PD18-03 THE IMPACT OF HOSPITAL VOLUME ON SHORT-TERM AND LONG-TERM OUTCOMES FOR PATIENTS UNDERGOING RADICAL NEPHROURETERECTOMY WITH UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD18)1 Apr 2020PD18-03 THE IMPACT OF HOSPITAL VOLUME ON SHORT-TERM AND LONG-TERM OUTCOMES FOR PATIENTS UNDERGOING RADICAL NEPHROURETERECTOMY WITH UPPER TRACT UROTHELIAL CARCINOMA Wilson Sui*, Daniel A. Barocas, Sam S. Chang, David F. Penson, Matthew J. Resnick, and Aaron A. Laviana Wilson Sui*Wilson Sui* More articles by this author , Daniel A. BarocasDaniel A. Barocas More articles by this author , Sam S. ChangSam S. Chang More articles by this author , David F. PensonDavid F. Penson More articles by this author , Matthew J. ResnickMatthew J. Resnick More articles by this author , and Aaron A. LavianaAaron A. Laviana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000861.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold standard for the treatment of upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNUx). While the surgeon/hospital volume-outcome relationship has been well established for resection of multiple other cancer types both within and outside of urology, it has never been examined for RNUx. METHODS: The National Cancer Database (NCDB) was queried for all cases of UTUC from 2004-2016. Average annual hospital volume for radical nephroureterectomy was calculated per hospital and subsequently stratified into tertiles. We considered high-volume to be the upper tertile, which was six or more RNUx per year and low-volume to be the lower two tertiles which was < 6 RNUx per year. Kaplan-Meier and Cox proportional hazards regression were used to identify independent predictors of overall survival, and logistic regression was used to identify predictors of perioperative outcomes. RESULTS: We identified 37,479 RNUx performed across 1,290 hospitals. There were no differences in baseline health or cancer staging between patients who presents at low vs high volume centers. For short-term perioperative outcomes, treatment at a high-volume center was associated with lower odds of both 30-day (OR 0.73, p = 0.015) and 90-day (OR 0.80, p = 0.016) mortality. In addition, there was lower odds of positive margin (OR 0.82, p = 0.036) and higher use of perioperative chemotherapy (OR 1.29, p <0.001). Median survival at a high-volume center was 66.2 months (95% CI 63.6 – 68.8) vs 63.6 months (95% CI 61.9 – 65.3) low volume center (p = 0.002). On multivariable survival analysis, treatment at a high-volume center was associated with improved hazards of survival (HR HR 0.914, 95% CI 0.859-0.972). This relationship for long-term survival remained consistent on sensitivity analysis where patients who died within 90 days of surgery were removed. CONCLUSIONS: Treatment at a high-volume hospital was associated not only with improved short-term perioperative outcomes such as 30- and 90-day mortality but also with improved hazards of survival long-term. The mechanism behind this is likely multifactorial with surgeon volume, facility experience, and ancillary support services all playing critical roles. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e376-e376 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wilson Sui* More articles by this author Daniel A. Barocas More articles by this author Sam S. Chang More articles by this author David F. Penson More articles by this author Matthew J. Resnick More articles by this author Aaron A. Laviana More articles by this author Expand All Advertisement PDF downloadLoading ...